The EM Educator Series: Ins & Outs of Hyperkalemia

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case 1:

A 69-year-old male is sent to the ED from the internal medicine clinic. He was being evaluated today for recurrent syncope. His potassium was 6.7 mEq/L.

Case 2:

A 53-year-old female presents with repeated vomiting and weakness. She is currently being treated for a urinary tract infection with TMP/SMX and takes an ACE inhibitor for hypertension.

Case 3:

A 84-year-old male presents with decreased urine output, weakness, and mental status changes. He has a history of heart failure and chronic kidney disease.

Considerations:

• What are the various etiologies of hyperkalemia? (Note: review the med list!)
• What are the clinical presentations of hyperkalemia?
• How sensitive are EKG changes? / Which are the most concerning?
• What are essential components of ED management, and where do we go wrong?
• Who needs emergent hemodialysis?

Suggested Resources:

• Articles
  • emDocs Cases HyperK
  • IBCC HyperK
  • Emergency Medicine Cases
  • EMCrit Critical HyperK
  • First10EM HyperK
  • REBEL EM ECG Changes
  • ECG Pointers
  • emDocs Insulin Dosing
  • PulmCrit LR vs. NS in HyperK
  • PulmCrit Zirconium Cyclosilicate
• Journal Articles
  • JEM – HyperK Controversies
  • WJEM – Predicting outcomes with ECG
  • Emergency Medicine Practice – HyperK